Enlarged Prostate (BPH)

What Is Enlarged Prostate (BPH), Causes, Symptoms, Exams and Tests, Treatment

What is enlarged prostate (BPH)?

Enlarged prostate, also known as benign prostatic hyperplasia (BPH), is a common condition that affects aging men. The prostate is a walnut-sized gland that surrounds the urethra, the tube that carries urine from the bladder out of the body. BPH occurs when the prostate gland gradually enlarges, causing it to squeeze or partially block the urethra.



The exact cause of BPH is not well understood, but several factors are believed to contribute to its development. Some of the key factors include:


BPH is associated with aging, and the risk increases with age. It is rare to find significant prostate enlargement in men younger than 40, but it becomes more prevalent as men get older.

Hormonal Changes:

Changes in hormonal balance, particularly the increase in levels of dihydrotestosterone (DHT), a hormone derived from testosterone, are thought to play a role in the development of BPH. DHT is believed to contribute to the growth of prostate cells.

Family History:

There is evidence to suggest a genetic predisposition to developing BPH. If a man has close male relatives who have experienced BPH, he may be at a higher risk.


While it might seem contradictory, low levels of testosterone have been linked to an increased risk of BPH. The relationship between testosterone and BPH is complex, and more research is needed to fully understand it.

Lifestyle Factors:

Certain lifestyle factors may contribute to the development or exacerbation of BPH. These include obesity, lack of physical activity, and a diet high in fat and red meat.

Chronic Inflammation:

Chronic inflammation in the prostate gland may also be a contributing factor to the development of BPH. Inflammation can cause cellular changes and promote the growth of prostate tissue.

Diabetes and Heart Disease:

Conditions like diabetes and heart disease have been associated with an increased risk of BPH. The exact mechanisms linking these conditions to BPH are not fully understood, but they may involve shared risk factors or common pathways.



It’s important to note that having an enlarged prostate doesn’t necessarily mean a person will experience symptoms, and the severity of symptoms can vary. Common symptoms of an enlarged prostate include:

Frequent Urination: The need to urinate more often, especially at night (nocturia), is a common symptom.

Urgency: A sudden and strong urge to urinate.

Weak or Intermittent Urine Stream: Difficulty in starting or maintaining a steady stream of urine.

Straining to Urinate: Difficulty in initiating urination, often requiring increased effort.

Incomplete Emptying: A feeling that the bladder hasn't emptied completely after urination.

Dribbling at the End of Urination: A dribble of urine may continue after finishing.

Urinary Retention: In severe cases, the inability to empty the bladder completely.

Bladder Infections: BPH can increase the risk of urinary tract infections (UTIs) and other complications.

It’s important to differentiate between an enlarged prostate and prostate cancer. While an enlarged prostate is a non-cancerous condition, prostate cancer is a malignant growth of cells in the prostate gland. If you experience symptoms of an enlarged prostate, it's advisable to consult with a healthcare professional for proper evaluation and diagnosis. Treatment options for an enlarged prostate can range from lifestyle changes and medications to surgical interventions, depending on the severity of symptoms and their impact on quality of life.


Exams and tests

If you suspect that you have an enlarged prostate or are experiencing symptoms related to it, it’s important to consult with a healthcare professional. They can conduct various exams and tests to diagnose and assess the condition. Common exams and tests for an enlarged prostate:

Digital Rectal Exam (DRE): This is a physical examination where a doctor inserts a gloved, lubricated finger into the rectum to feel the size, shape, and consistency of the prostate gland. An enlarged prostate is often detectable through this exam.

Prostate-Specific Antigen (PSA) Blood Test: PSA is a protein produced by the prostate gland, and elevated levels can indicate a potential issue, such as an enlarged prostate or prostate cancer. However, an elevated PSA level is not specific to an enlarged prostate and can be caused by various factors.

Urinalysis: This test examines a sample of urine for signs of infection or other abnormalities that might be related to an enlarged prostate.

Uroflowmetry: This test measures the flow and force of urine during voiding. It helps to assess the severity of urinary obstruction and can be useful in diagnosing an enlarged prostate.

Transrectal Ultrasound (TRUS): This imaging test uses sound waves to create an image of the prostate gland. It can help determine the size of the prostate and identify any abnormalities.

Cystoscopy: In this procedure, a thin, flexible tube with a camera (cystoscope) is inserted into the urethra to examine the inside of the prostate and bladder. It can help identify any blockages or abnormalities.

Urodynamic Tests: These tests assess how well the bladder, sphincters, and urethra are storing and releasing urine. They can help identify issues related to an enlarged prostate, such as bladder dysfunction.

Prostate Biopsy: In some cases, a biopsy may be recommended, especially if there are concerns about prostate cancer. During a biopsy, a small tissue sample is taken from the prostate for examination under a microscope.



The treatment for an enlarged prostate, also known as benign prostatic hyperplasia (BPH), depends on the severity of symptoms and the impact on an individual's quality of life. It’s important to note that if you suspect you have an enlarged prostate or are experiencing symptoms, it’s crucial to consult with a healthcare professional for an accurate diagnosis and personalized treatment plan. Common treatment options for BPH include:

Watchful Waiting/Active Surveillance:

In some cases, especially if symptoms are mild, the healthcare provider may recommend monitoring the condition without immediate intervention.

Lifestyle Modifications:

Changes in lifestyle can sometimes help alleviate symptoms. This may include limiting caffeine and alcohol intake, managing fluid intake, and avoiding activities that can worsen symptoms, such as delaying urination.


Alpha-blockers: These medications help relax the muscles around the prostate, making it easier to urinate.

5-alpha reductase inhibitors: These drugs can reduce the size of the prostate by blocking the conversion of testosterone to dihydrotestosterone (DHT).

Combination therapy: In some cases, a combination of alpha-blockers and 5-alpha reductase inhibitors may be prescribed.

Minimally Invasive Procedures:

Transurethral Microwave Thermotherapy (TUMT): This procedure uses microwave energy to reduce the size of the prostate.

Transurethral Needle Ablation (TUNA): Radiofrequency energy is used to heat and destroy excess prostate tissue.

Surgical Interventions:

Transurethral Resection of the Prostate (TURP): A common surgical procedure where excess prostate tissue is removed using a special instrument inserted through the urethra.

GreenLight Laser Therapy: This involves using a laser to vaporize excess prostate tissue.

Holmium Laser Enucleation of the Prostate (HoLEP): This is a newer laser surgery that removes prostate tissue.

Prostatic Urethral Lift (UroLift):

This is a minimally invasive procedure where implants are used to lift and hold the enlarged prostate tissue away from the urethra, reducing obstruction.



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